Why health reform should come now

The whole world is in recession. But the United States is the only wealthy country in which the economic catastrophe will also be a health care catastrophe. Millions of people will lose their health insurance along with their jobs, and therefore lose access to essential care.

Why has the Obama administration been silent, so far, about one of his key promises during last year's campaign – guaranteed health care for all Americans?

Let's talk about the magnitude of the looming health care disaster.

Just about all economic forecasts, including those of the Obama administration's economists, say we're in for a prolonged period of high unemployment. That means a sharp rise in the number of people with no health insurance.

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After the economy slumped at the start of this decade, 5 million people joined the uninsured – and that was with the unemployment rate peaking at only 6.3 percent. This time the administration says that even with its stimulus plan, unemployment will reach 8 percent, and will stay above 6 percent until 2012. Many independent forecasts are even more pessimistic.

Why, then, aren't we hearing more about ensuring health care access?

Now, it's possible those of us who care about this issue are reading too much into the administration's silence. But let me address three arguments that I suspect Obama is hearing against moving on health care, and explain why they're wrong.

First, some are arguing that a major expansion of health care access would be too expensive right now, given the vast sums we're about to spend trying to rescue the economy.

But research sponsored by the Commonwealth Fund shows that achieving universal coverage with a plan similar to Obama's campaign proposals would add “only” about $104 billion to federal spending in 2010 – not a small sum, of course, but not large compared with, say, the tax cuts in the Obama stimulus plan.

It's true that the cost of universal health care will be a continuing expense, far into the future. But that has always been true, and Obama has always claimed his health care plan was affordable. The temporary expenses of his stimulus plan shouldn't change that calculation.

Second, some people in Obama's circle may be arguing that health care reform isn't a priority right now, in the face of economic crisis.

But helping families buy health insurance as part of a universal coverage plan would be at least as effective at boosting the economy as the tax breaks in the stimulus plan – and would have the added benefit of directly helping families get through the crisis, ending one of the major sources of Americans' current anxiety.

Finally – and this is, I suspect, the real reason for the administration's silence – there's the political argument that this is a bad time to push fundamental health care reform, because the nation's attention is on the economic crisis. But if history is any guide, this argument is precisely wrong.

Don't take my word for it. Rahm Emanuel, White House chief of staff, has declared that “you never want a serious crisis to go to waste.” Indeed. FDR was able to enact Social Security in part because the Great Depression highlighted the need for a stronger social safety net. The current crisis presents a real opportunity to fix the gaping holes that remain in that safety net, especially with health care.

Obama really, really doesn't want to repeat the mistakes of Bill Clinton, whose health care push failed politically partly because he moved too slowly: By the time his administration was ready to submit legislation, the economy was recovering and the sense of urgency was fading.

One more thing. There's a populist rage building, as Americans see bankers getting huge bailouts while ordinary citizens suffer.

This is no time to let campaign promises of guaranteed health care be quietly forgotten. It is, instead, time to put the push for universal care front and center. Health care now!